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Single rooms in hospitals 'increase anxiety' among nursing staff


Nurses fear single room-only hospitals risk damaging patient safety and team work, but patients generally prefer having their own room, according to latest analysis.

Increasingly, new hospital design includes greater proportions of single room accommodation and in some cases all single inpatient rooms, highlighted the authors of the research.

The first NHS hospital in England to have 100% single in-patient rooms in all wards and high-acuity areas opened near Tunbridge Wells in Kent during 2011.

Their study, published online by the National Institute for Health Research, examined the impact of moving from large bays and traditional “Nightingale-style” wards to 100% single room accommodation at the new Tunbridge Wells Hospital in Pembury.

The two-year project considered the views of staff and patients before and after the move to the new, purpose-built hospital where every room has a single bed and en suite bathroom.

survey tool 

They found high levels of anxiety among nursing staff trying to adapt to the new working environment. While nurses could see the benefits of single rooms when it came to privacy, confidentiality and for visitors, they also flagged up a range of issues.

Key concerns included difficulty in monitoring patients, especially when it came to keeping an eye on those at risk of falls, though the researchers found no clear evidence that patient safety had been affected.

Staff also found it harder to find each other and said they had less contact with colleagues, so it was more difficult to observe other people’s work, share ideas or ask for help.

Nurses were asked their opinion at different points during the study, which involved researchers from the National Nursing Research Unit at King’s College London, Southampton University and Imperial College Business School.

Each time, less than 18% of staff said they preferred 100% single rooms, with most saying they would rather have a combination of beds in single rooms and in bays.

Sixty-two per cent of respondents in the staff survey felt the response to calls was worse in single-bedded rooms. Ratings of teamwork, handovers and communication between different healthcare professions were lower after the move.

“Nurses found it difficult to monitor multiple patients as they didn’t have a line of sight across a bay of beds”

Jill Maben

Nurses also reported feeling “pulled” and that they were not able to spend as much as they wanted with some patients, or alternatively getting “stuck” in one room when they needed to be elsewhere.

In contrast, the majority of patients were in favour of single rooms, reporting they were more comfortable, less noisy and that it was easier to get to sleep.

Lead study author Professor Jill Maben, director of the NNRU at King’s, said the research painted a mixed picture of the advantages and disadvantages of 100% single occupancy facilities.

“On the one had we have seen improved patients experience because of benefits such as privacy and noise reduction while on the other some patients have reported feeling isolated or lonely,” she said.

“For staff the picture is even more complex,” she said. “Nurses found it difficult to monitor multiple patients as they didn’t have a line of sight across a bay of beds and this was especially important for older vulnerable patients at risk of falling.”

The report suggested that training and rehearsing new ways of working before making a shift to single room working could help improve the experiences of both patients and staff.


What do you think of single-room wards?

Would you prefer this way of working? What advantages and disadvantages could this ward structure present?

At 1pm today (Wednesday 8 April) we’re going to be hosting a live discussion on Twitter. To join in simply search for #NTtwitchat and use this hashtag in all your tweets.


Readers' comments (23)

  • this is when people are nursed in a cohort
    were staff are employed to observe patents
    including their vulnerability and able to do continue risk assessment to cover all.
    And as for people feeling isolated it can be a number of thing from medical,what the main thing is to treat the patient safely, Quickly, and constructive the longer they stay in hospital the more RED signs arise

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  • there is nothing natural about adults being institutionalised and expected to sleep with a roomful of other sick individuals. however, the feeling of being spied on 24/7 unless you are unconscious in intensive care is not highly desirable either. private rooms fine - glass panels like the one above for all and sundry to stare at you through like a zoo exhibit - No, no, no!

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  • ok how long are people to stay in acute beds I thought it was until medically fit and
    able to go home or in other accomidation ?
    yes!!!!! the above room is not descreet.

    7-Apr-2015 12:19pm
    how would you deal with this matter?.

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  • If patients are to be nursed in single rooms then more staff are needed to care for them and that is NEVER going to happen

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  • 7-Apr-2015 12:19pm
    how would you deal with this matter?.

    the same as the rest of modern state of the art hospitals in western Europe.

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  • michael stone

    The interesting part of this, is the predictable difference in 'perspectives' between the patients and the nurses [both being valid].

    I must admit I was surprised (because it 'intuitively' looks very expensive) to read this:

    'The first NHS hospital in England to have 100% single in-patient rooms in all wards and high-acuity areas opened near Tunbridge Wells in Kent during 2011.'

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  • Sorry, this argument won't wash with me! In 2006 my mother was nursed in a 7-bedded bay in a major regional hospital in the South-East. All the buzzers in the ward were ringing constantly, my mother pulled out her IV catheter at regular intervals and on one occasion I arrived to find the confused elderly man from the next bed trying to climb in with her. On another occasion, a retired physiotherapist (a patient in the same bay who was unable to get out of bed) said she'd pressed her own buzzer after seeing another elderly patient climb over her cot-sides and fall. She told me she finally, and painfully, managed to reach the crash button on the wall behind her bed when the lady had been on the floor for 40 minutes, without a member of staff unswering the buzzer!

    Please don't try to pretend that bays work any better than single rooms.

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  • all ours are two bedded which seems very reasonable for patients unless you have private insurance and have a choice or are seriously ill. obviously for nursing all stuffed in one room is far easier and faster but then patients and their privacy and dignity must come first. I would never consider more than two as a patient unless was too ill to make that choice. I find the NHS system totally distasteful. a friend and consultants wife and former nurse managed to get a single room in a newish gerrybuild hospital but then their was black mould growing up the wall underneath the window and a more depressing room I have never seen! For what should be a modern health service an utter and despicable disgrace.

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  • HCSW

    It is not only about comfort, discomfort or an anxiety. There is a legal requirement to isolate patients with certain diseases: C-diff, norovirus, etc. Besides, sometimes there is a problem with male to female ratio. On two occasion I remember the situation when 3 beds in a 4bedder where empty, because there was appropriate gender for an admission. I do like nightingale wards, but medical, palliative and specialistic services should be as a single rooms. Long term rehab? Even 10 bedders: social aspects of the hospital stay are also important, and it never meant to match the luxiourous cruise trip accomodation....

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  • If I was admitted to hospital I would prefer a single room, for privacy and peace. I would not like the patients and their visitors hearing all my personal details, curtains to not block conversations. As a poor sleeper a single room would prevent t me from annoying other patients.

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